Functional Preservation and Oncologic Control following Robot-Assisted versus Laparoscopic Radical Prostatectomy for Intermediate- and High-Risk Localized Prostate Cancer: A Propensity Score Matched Analysis.

Wen Deng,Gongxian Wang,Yunqiang Xiong,Yulei Li,Ru Chen,Luyao Chen,Cheng Zhang,Xiaofeng Cheng,Bin Fu,Ting Sun,Hao Jiang,Weipeng Liu,Ke Zhu,Xiaoqiang Liu,Xiaochen Zhou,Pierfrancesco Franco

doi:10.1155/2021/4375722

Abstract

Aim To evaluate the urinary continence (UC), erectile function, and cancer control obtained following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for intermediate- and high-risk localized prostate cancer (PCa). Materials and Methods 232 patients bearing intermediate- and high-risk localized PCa were enrolled in this study. Perioperative, functional, and oncological outcomes were analyzed after applying the propensity score matched method. Results Within the matched cohort, the RARP group was corrected with a significantly shorter mean operative time than the LRP group (p < 0.001). Patients in the RARP arm were also at a lower risk of ≤ Grade II complications than those in the LRP group (p = 0.036). Meanwhile, the proportions of transfusion and ≥ Grade II complications in the RARP group were similar to those in the LRP group (p = 0.192 and p = 1.000, respectively). No significant differences regarding the rates of pT3 disease and positive surgical margin existed between the two groups. RARP versus LRP tended to a significantly higher percentage of UC recovery within the follow-up period. Significant differences were also found between the RARP and LRP arms in terms of erectile function at postoperative 6 months and the last follow-up (p = 0.013 and p = 0.009, respectively). Statistical comparability in biochemical recurrence-free survival was observed between the two groups (p = 0.228). Conclusions For the surgical management of intermediate- and high-risk localized PCa, RARP tended to a lower risk of ≤ Grade II complications and superior functional preservation without cancer control being compromised than LRP.

Highlights

Prostate cancer (PCa), the second most common cancer and the fifth dominating cause of cancer-specific mortality among men around the world [1, 2], has been increasingly discovered due to the widespread diffusion of prostatespecific antigen (PSA) screening, markedly the localized ones [3,4,5]
With the superiority of surgical robots in a three-dimensional magnified vision of the surgical field, improved dexterity, and high precision during the surgical procedure, robot-assisted radical prostatectomy (RP) (RARP) is considered a great evolution of minimally invasive surgery to reduce the difficulty associated with complex laparoscopic surgery [12], and it has been widely disseminated for localized PCa since 2001 [13]
No surgery was converted to an open approach in either arm. e patients in the RARP group had a significantly shorter mean operative time (OT) than those in the laparoscopic RP (LRP) group (146.0 versus 167.9 min, p < 0.001)

Summary

Introduction

Prostate cancer (PCa), the second most common cancer and the fifth dominating cause of cancer-specific mortality among men around the world [1, 2], has been increasingly discovered due to the widespread diffusion of prostatespecific antigen (PSA) screening, markedly the localized ones [3,4,5]. In 2020, surgery was not recommended in patients with low-grade, low-volume, or Gleason 6 PCa, in consideration of the minimal clinical benefit and substantial adverse effects following surgery, while RP was considered as an appropriate choice for men with intermediate- and high-risk disease [11]. With the superiority of surgical robots in a three-dimensional magnified vision of the surgical field, improved dexterity, and high precision during the surgical procedure, robot-assisted RP (RARP) is considered a great evolution of minimally invasive surgery to reduce the difficulty associated with complex laparoscopic surgery [12], and it has been widely disseminated for localized PCa since 2001 [13]. Far, whether the advantage of RARP over LRP mentioned above could translate into superior functional preservation and oncological control remains inconclusive due to the scarcity of high-level evidence comparing RARP and LRP for localized PCa [12, 16]. No study focusing on the comparison between RARP and LRP for patients with intermediate- and high-risk localized PCa has been reported yet, while cogent evidence comparing the efficacy and safety of RARP and LRP for intermediate- and high-risk localized PCa is of great clinical importance

Methods

Results

Conclusion